Continuous inter-limb coordination deficits in children with unilateral spastic cerebral palsy

Age related progression of lower limb coordination during gait in children with cerebral palsy without a history of surgical intervention

Walking requires precise movement between body segments, referred to as intersegmental coordination, which is an important factor in efficient motor performance. For children with cerebral palsy (CP), who often demonstrate an impaired neuromuscular system, intersegmental coordination has been shown to be different when compared to their typically developed (TD) peers. However, how intersegmental coordination changes over time in these children is unclear. The aim of this study was to quantify age-related changes in intersegmental coordination in children with bilateral CP without a history of surgical intervention and to compare to control groups of children with TD of similar age, weight, and height. A retrospective analysis of 162 children with bilateral CP who had a baseline and follow-up 3D gait assessment, and no history of surgical intervention, was conducted. Two age, weight, and height control groups of children with TD were included. A full 3-dimensional kinematic analysis was performed, and continuous relative phase analysis of the thigh-shank and shank-foot, while walking at a self-selected walking speed, was used to measure intersegmental coordination. Differences were present for children with CP compared to children with TD at baseline for thigh-shank intersegmental coordination. However, children with CP demonstrated a change over time with a move towards TD patterns at follow-up assessment. This study provides insights into the acquisition and stabilisation of intersegmental coordination between children with CP and TD.

Intra-limb joint coordination measures of upper limb and hand movements: A systematic review

BACKGROUND

People with central nervous system disorders typically have difficulties in coordination of the upper limb and hand movements, which significantly impairs their activities of daily living. Laboratory-based measures can provide quantitative and objective information about intra-limb coordination to aid the rehabilitation process of this population. However, there is currently no comprehensive review of laboratory-based measures.

RESEARCH QUESTIONS

The aim of this review was to identify and summarize laboratory-based intra-limb coordination measures for different upper limb and hand movements.

METHODS

Searches were performed in the CINAHL, Embase, IEEE Xplore, MEDLINE, PubMed and Web of Science databases to identify studies published between 2013 and 2022. Two authors independently performed paper selection, data extraction and quality assessment.

RESULTS

21 papers were identified, and six types of coordination measures were classified. These included principal component analysis, continuous relative phase analysis, correlation analysis, regression analysis, uncontrolled manifold analysis, and uncorrelated surrogate data analysis, in descending order of occurrence. Regarding psychometric properties, all measures demonstrated good discriminative validity. However, only the principal component analysis approach and the continuous relative phase analysis approach were found to have good convergent validity and responsiveness, respectively. In terms of their practicality, these measures were primarily utilized for quantifying coordination in individuals with neurological disorders, with a greater emphasis on the coordination of upper limb movements rather than hand movements.

SIGNIFICANCE

This review summarized and critiqued the characteristics of six types of joint coordination measures. Researchers and clinicians should therefore select appropriate measures based on individual needs. Future research should continue on analysing coordination in individuals with pathological conditions and exploring the application of these measures in quantifying hand movement coordination, to advance current knowledge and inform rehabilitation practices.

Development of the Relationships Among Dynamic Balance Control, Inter-limb Coordination, and Torso Coordination During Gait in Children Aged 3-10 Years

Knowledge about the developmental process of dynamic balance control comprised of upper arms and upper legs coordination and trunk and pelvis twist coordination is important to advance effective balance assessment for abnormal development. However, the mechanisms of these coordination and stability control during gait in childhood are unknown.This study examined the development of dynamic postural stability, upper arm and upper leg coordination, and trunk and pelvic twist coordination during gait, and investigated the potential mechanisms integrating the central nervous system with inter-limb coordination and trunk and pelvic twist coordination to control extrapolated center of the body mass (XCOM). This study included 77 healthy children aged 3-10 years and 15 young adults. The child cohort was divided into four groups by age: 3-4, 5-6, 7-8, and 9-10 years. Participants walked barefoot at a self-selected walking speed along an 8 m walkway. A three-dimensional motion capture system was used for calculating the XCOM, the spatial margin of stability (MoS), and phase coupling movements of the upper arms, upper legs, trunk, and pelvic segments. MoS in the mediolateral axis was significantly higher in the young adults than in all children groups. Contralateral coordination (ipsilateral upper arm and contralateral upper leg combination) gradually changed to an in-phase pattern with increasing age until age 9 years. Significant correlations of XCOMML with contralateral coordination and with trunk and pelvic twist coordination (trunk/pelvis coordination) were found. Significant correlations between contralateral coordination and trunk/pelvis coordination were observed only in the 5-6 years and at 7-8 years groups.Dynamic postural stability during gait was not fully mature at age 10. XCOM control is associated with the development of contralateral coordination and trunk and pelvic twist coordination. The closer to in-phase pattern of contralateral upper limb coordination improved the XCOM fluctuations. Conversely, the out-of-phase pattern (about 90 degrees) of the trunk/pelvis coordination increased theXCOM fluctuation. Additionally, a different control strategy was used among children 3-8 years of age and individuals over 9 years of age, which suggests that 3-4-year-old children showed a disorderly coordination strategy between limb swing and torso movement, and in children 5-8 years of age, limb swing depended on trunk/pelvis coordination.